| NPI | 1003847781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D77880) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD436570) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-06-30 |